Outcome of intensive outpatient rehabilitation and bracing in an adult patient with Scheuermann’s disease evaluated by radiologic imaging—a case report
© The Author(s). 2016
Published: 14 October 2016
No studies examine the efficacy of intensive specific physical therapy (PT) exercises along with brace for the adult with Scheuermann’s kyphosis (SK).
The aim of this study was to examine the effects of intensive PT based on the Barcelona Scoliosis Physical Therapy School (BSPTS) and SpinoMed brace on a 76-year-old female with SK.
A 76-year-old female, diagnosed with SK as an adolescent, presented in October 2014 with thoracic hyperkyphosis T1 to T12 Cobb angle of 85° and lumbar hyper lordosis L1 to L5 Cobb angle of 70°. Lumbar scoliosis T12-L5 with 21° Cobb and vertebral rotation 2. Trunk translation in the sagittal plan was 4.5 cm. Intermittent low back pain 6/10 at worst. Quality-of-life score was 3.8 (SRS 22 questionnaire).
The PT regimen included one-hour Schroth exercise sessions three times per week for 6 months. In addition, a home exercise program (HEP) was recommended. Patient also wore a SpinoMed brace for 2 h per day. All tests and measurements were recorded before and after treatment.
After a six-month treatment period the kyphosis Cobb angle was reduced to 70° and the lordosis Cobb angle improved to 57°. A recent x-ray (October 2015) showed another improvement in the sagittal plane with thoracic kyphosis measuring 64° and lumbar lordosis 55°. Lumbar curvature decreased to 12° and vertebral rotation to 1. The quality-of-life score showed improvement with a score of 4.5 on the SRS 22. Pain score diminished to 2. Trunk deviation improved by 2.2 cm.
These findings suggest that intensive and specific PT and bracing were successful for the treatment of this adult patient with SK.
Scheuermann’s disease (SD), or Scheuermann’s kyphosis (SK), is a condition developed in the early adolescence in which the normal round-back in the upper spine (called a kyphosis) is increased . This condition has been reported to occur in 0.4 to 8.3 % [OR IS IT 0.8 %??] of the general adolescent population, with an equal distribution between sexes. However, the prevalence and incidence of hyperkyphosis in older adults increases and varies from approximately 20 to 40 % . Most people with SK have an increased round-back (e.g. a hunch back or hump back) but no pain . Nonetheless, untreated kyphosis in the growing child may lead to progressive deformity of the spine and back pain .
Several studies report that adolescents with SK who have undergone PT showed improvement in Cobb angle and respiration [5–10]. However, no studies have examined the efficacy of intensive outpatient specific physical therapy exercises for kyphosis along with brace for the management of adults with SK.
The aim of this study was to observe the effect of a six-month intensive physical therapy program based on the BSPTS method – using the Schroth principles and the SpinoMed brace – on the Cobb angle, pain, quality of life, core strength and back strength of a 76-year-old woman with SK.
Trunk Elongation – and expansion throughout the trunk to de-collapse the spine.
- 2.Symmetrical Sagittal Straightening – More specific tension and expansion; in contrast to treatment for scoliosis and other sagittal plane deformities, the correction during this phase is symmetrical for SK, meaning that exercises are identical for both sides of the trunk (right and left):
Thoracic expansion bilaterally in the frontal plane and in a posterior to anterior (PA) direction in the sagittal to reduce the hyperkyphosis thoracic;
Lumbar expansion bilaterally as well in the frontal plane and in an anterior to posterior (AP) direction in the sagittal plan to reduce the hyperlordotic low back.
- 3.Shoulder Traction (see Fig. 2) – Isometric tension that is performed bilaterally starting at the shoulder region enhances the frontal plane correction/expansion of the thorax.
Corrective Breathing - Inhaling while maintaining all of the correction principles allows the subject to feel an increased expansion in his/her initially collapsed regions. This is done simultaneously on the right and left sides of the patient with the goal of expanding in a back-to-front direction in the thorax as well as laterally.
Muscle Activation by Increasing Tension - Isometric tension to achieve the best possible correction and muscle balance. From one side it stabilizes the correction and from the other side it increases the proprioceptive corrective input so that it helps to integrate the ‘corrected body schema’ in the brain.
During the period of treatment the patient was monitored daily. On days when the therapist was not present, the patient reported which exercises she performed. All tests and and measurements were repeated 6 months after the evaluation.
These findings suggest that intensive PT utilizing the BSPTS/Schroth method and bracing was a successful method of treating this adult patient with SK and that patient compliance with home exercises and brace was an important factor contributing to her results.
I would like to thank the patient for providing detailed information and necessary imaging to complete this case report. I would also like to thank Dr. Manuel Rigo for his support and invaluable contribution to my education.
This article has been published as part of Scoliosis and Spinal Disorders Volume 11 Supplement 2, 2016. Research into Conservative Management of Spinal Deformities: Short Articles from the SOSORT 2015 Meeting. The full contents of the supplement are available online http://scoliosisjournal.biomedcentral.com/articles/supplements/volume-11-supplement-2.
Availability of data and materials
Data for this case report is given fully in this report and material can be provided upon request from the author.
HB designed the specific and individual exercise program for the patient, carried out the treatment and guided the family on the program. HB also collected and analyzed the data.
Owner of SchrothNYC, New York, NY USA.
The author declares that he/she has no competing interests.
Consent for publication
Written informed consent was obtained from the patient for treatment, photos, and publication of this case study. A copy of the written consent is available for review by the Editor of this journal. Written consent was obtained from the patient for publication of this study.
Ethics approval and consent to participate
Ethics approval not applicable. Written informed consent was obtained from the patients for the publication of their cases and any accompanying images. A copy of the written consent is available for review from the Editor-in-Chief of this journal.
No institutional Review Board needed to approved study. The patient provided informed consent prior to the examinations.
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